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Permit (118) � CITY OF TIGARD PLUMBING PERMIT f COMMUNITY DEVELOPMENT Permit#: PLM2017-00507 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2017 Parcel: 1 S 134AD01700 Jurisdiction: Tigard Site address: 11373 SW LAKEWOOD CT Project: DUARTE-SIGUENZA Subdivision: ENGLEWOOD Lot: 57 Project Description: Relocating clothes dryer vent into garage from adjacent wall. Contractor: OWNER Owner: DUARTE-SIGUENZA, CESAR CESAR DUARTE-SIGUENZA 11373 SW LAKEWOOD CT 11373 SW LAKEWOOD CT TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-730-2729 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Clothes Washer 12/10/2017 $25.02 Specifics: 1 12%State Surcharge- 12/10/2017 $8.70 Plumbing Type of Use: MF 47 ea Minimum Fee Adjustment- 12/10/2017 $47.48 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: ixCz7Aof . Flee Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicatic CEIVE Building Fixtures City Of Tigard OFT 6 2017 Receect �, 7/if , 111 13125 SW Hall Blvd.,Tigard,OR 97223 Dates„, - Permit No.: /)L�M'�i+1{ 7, t.56 7 C Phone: 503.718.2439 Fax: 503. $ OF yy yR /" { r�cL.�! Inspection Line: 503.639.4175 TIG Dale/BY: Other Permit No.: 0,CO2017, �� rlc;, t:u P Internet www.tigard-or.gov BUILDING DIVISION Noe MAY°: loorip s. f ®S�Peaeafor TYPE OF WORK �PPkmealal lnformalloa FEE* SCHEDULE ❑New construction ❑Demolition For s peatd information use checklist ❑Addition/alteration/replaceinent Description I Qty. I Ea �Rther:was/�t Total nl-/s C1L %G� New I-2-family dwellings(includes 100 it for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building Et-Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire JOB SITE INFORMATION AND LOCATION Site sprinkler( ft.) Page 2 utilities: Job site address: 1/33 7'3 5(4.,, i6 ,,rd Catch basin or area drain I 18.76 t Drywall,leach line,or trench drain 1 City/State/ZIP: Vial 4 `j2, 471422 age 2 Suite/bldgJapt no.: I Project nameFooting drain(no.linear ft.:_.,) Page 2 I-C" S, ' L4 Manufactured home utilities 50.03 Cross street/directions to job site: �j'e 1/5 ( sip' .zaere) Manholes 18.76 l/ Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:__) Page 2 Subdivision ,erJ Water service(no.linear ft.: ) Page 2 0-ty)/�,,,,,t) I Lot no.: J�""/ Fixture or item: Tax map/par+cel no*:✓ /5/34//.I)-©17U ) Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 GLL �/� Clothes washer 1 25.02 j ), i.ei if/2l044, /lvC- 4Z1? /e/Cly . S' hilt) '-! r�jr "moi» pip-s Dishwasher 25.02 4.Cjt�'J1 L'�.a-ir (.i-A// Drinking fountain 25.02 Ejectors/sump 25.02 i OPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: -,� /N. O4..�►-ee- --5 Fixture/sewer cap 25.02 11+'MZk Address: /1373 S t/ G4'4,1 t-- Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: ?rc�,a.t60/ dcm3 Hose bib 25.02 Phare:(5213)730--9,7 g Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business came: Cry Y/ Medical gas(value:$ ) Page 2 iAd Contact name: Primer 12.51 Address: Roof drain(commercial} 12.51 Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51 E-mail: eMc4 old L1'� t '�SN, e' .h Urinal 25.02 `-1 CONTRACTOR Water closet 25.02 Business name: CT Water heater 37.52 Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal ,/5-2,4.-, Phone:( ) I Fax:( ) Minimum permit fee: $72.50 Til.)Z Plan review (25%of permit fee) CCD Lic.: Plumbing Lic.no.: Authorized signature;,---77�> State surcharge(12%of permit fee) 70 >�a .,- �� '�," TOTAL PERMIT FE `+/aw i!'� Print name: -�'�t/ rn• J�Iaiiii--S3Icy, 7z/V1/1 I This permit application expires it permit is not obtained within 180 days t atter tr tms heen accepted s.eompkte "Fee methodology set by Tri-Cou�y Building industry Scrvicc Board. 1:1&tildinglPermitoLmu-Parmiapp.do. 10/OV09 440.4616T(io.coMlwEB) Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities �• Fee(ea} Total Square Footage: Permit Fee: Footing drain-1"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee; Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$7230 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Ins tions or Fees Fee(ea) Total each additional$100.00 or fraction thereof,to pee and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Rept / Plan review is required for any of the following. Work Performed: Capped Added Relocate Please check all that apply. Baptistry/Font Bath -Tub/Shower 0 Any new commercial building with water service 2"and -Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OA.R918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -4" Isometric or Riser Diagram Car Wash Drain 0 Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic--food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\CESAR\Downloads\PLMF_PermitApp(3).doc 2